Supplement 2
A statement of educational, scientific and research activities for the neuroradiologists
in Latvia
Neuroradiology as a special part of radiology is a clinical specialty which consists at the
Latvian university hospitals of three main branches: diagnostic, educational and research. The
clinical diagnostic comprises conventional and innovative neuroradiological investigations
and interventions, tutorials, interdisciplinary councils and conferences, including outpatient
and out-clinic consultations. Diagnostic neuroradiology is a team work consisting of several
steps: prescription of investigation, choice of protocol, investigation, imaging study and
preliminary conclusion, exchange of viewpoint with clinicians- neurologists, neurosurgeons,
psychiatrists etc, finally leading to consensus. Each step of this logical chain is consequential
but a special relevance two of them: prescription and exchange of viewpoint with clinicians
must be emphasized.
The current Latvian education system in radiology embraces three mandatory consecutive
steps: undergraduate training carried out during the 3rd, 5th and 6th study years at the
university program „Medicine”, post- graduate 4 year training program in general
radiology and continuing medical education (CME). Neuroradiology is the part of training in
the program of Diagnostic Radiology. The theoretical and practical training in neuroradiology
and credit system is based on requirements of the recommendations from the European
Association of Radiology “Radiology Training in Europe” and European Training Charter for
Medical Specialists, UEMS. Regular visiting scholarship and exchange programs for
fellowship in neuroradiology are performed in the frames of residentship, doctoral programs
and CME. CME is a yearly program of educational activities in neuroradiology to guarantee
the maintenance and upgrading of knowledge, skills and competence following completion of
post-graduate training. A credit system for CME is utilized. Category 1 points can be earned
by attendance at neuroradiological courses, meetings, seminars and conferences with CME
approval from national professional authorities. We offer yearly 6-10 CME courses in
neuroradiology or joint disciplines at two different educational levels: basic courses aimed at
residents, young certificated radiologists and physicians with practical experience in their
specialty, and advanced courses in new techniques for experienced physicians and
neuroradiologists. Special educational courses, seminars and lectures in neuroradiology for
doctors of other specialties (neurologists, psychiatrists, family doctors etc.) have been
prepared and carried out by most experienced and dedicated neuroradiologists on the regular
basis. Our professors and lecturers are regularly invited speakers at the neuroradiological
courses organized by ESNR and ESR: postgraduate training programs during ECR, ECNR,
ERASMUS courses etc.
A clinically oriented research in neuroradiology is performed by students, medical doctors
and lecturers within the framework of undergraduate, post-graduate training, doctoral works,
projects of the Latvian Academy of Science, international grants and interdisciplinary
projects. Knowledge of basic elements of scientific methods and evidence base, including
statistics is critical for assessment and understanding of published papers and promotion of
personal research. Therefore we start to involve students in the scientific work already at the
undergraduate level. The 5th and 6th year students who have showed a special interest in
neuroradiology may take the opportunity to participate in clinical research trials or perform
an independent study. During the post-graduate training the elaboration and presentation of
an independent clinically orientated study at the 2nd, 3rd and 4th year is mandatory. One third
of the chosen topics are in neuroradiology. To be accepted in the doctoral program the
aspirant has to prepare and submit to the commission a package of appropriate documents
including detailed annotation of the work, foreruns, publications, etc. In case of a positive
preliminary conclusion the applicant have to be passed successfully by the commission a
competitive interview. Presently we have 5 doctoral and 4 postdoctoral students in
neuroradiology. Currently, the main research branches and themes in the diagnostic and
interventional neuroradiology are in our country: (1) Functional MRI in surgery planning and
follow-up of glial tumors. (2) Brain perfusion disposition in acute stroke. (3) Brain ageing,
early cognitive disturbances and dementias. (4) CSF flow patterns in patients with
hydrocephalus and Chiari I malformation. (5) Imaging of toxic brain injury. (6) MRI in
multiple sclerosis. (7) Endovascular treatment of intracranial aneurisms. (8) Endovascular
treatment of acute ischemic stroke. (9) Endovascular treatment of intracranial arteriovenous
malformations. (10) Intracranial angioplasty and stenting.
Prof. Gaida Krumina MD PhD,
President of the Latvian Association of Neuroradiology